Nursing Clinical Practice Guide
Clinical Scenario: You are the nurse caring for Mr. Johnson, a 45-year-old who presented to the clinic with sudden onset of right-sided facial droop and inability to close his right eye. He is diagnosed with Bell's palsy and is being discharged with a prescription for prednisone and instructions for self-care.
Nursing Intervention Strategy:1. Assessment: Perform a thorough neurological assessment focusing on cranial nerve VII. Use a penlight to check corneal reflex and assess for lagophthalmos. Ask about eye pain, dryness, or blurred vision. Assess ability to eat, drink, and articulate words clearly.2. Nursing Care & Patient Education:• Eye Care: Teach and demonstrate application of preservative-free artificial tears every 1-2 hours while awake. Instruct to wear sunglasses or protective glasses outdoors. Teach how to tape the eyelid gently closed at night using paper tape, applying from the cheekbone to the eyebrow to avoid putting pressure on the cornea.• Medication: Emphasize the importance of taking prednisone exactly as prescribed (often a tapering dose) and not stopping abruptly. Discuss potential side effects (increased appetite, insomnia, mood swings).• Facial Care: Recommend gentle facial massage from the chin upward to promote circulation, not vigorous rubbing. Encourage gentle facial exercises like smiling, frowning, and puffing cheeks in front of a mirror.• Nutrition & Communication: Suggest eating soft foods, chewing on the unaffected side, and using a straw for liquids. Be patient with speech and provide emotional support, as the change in appearance can be distressing.3. Patient Safety and Precautions:• Contraindication: Do not use viscous ointments in the eye during the day unless specifically instructed, as they can blur vision. Nighttime ointments may be prescribed.• Monitoring: The patient must return immediately if they experience severe eye pain, sudden vision changes, or signs of infection (redness, purulent discharge).
Nursing Procedure & Medication Flow
Eye Protection Procedure:1. Wash hands.2. Have patient look up.3. Instill 1-2 drops of artificial tears into the lower conjunctival sac of the affected eye.4. If taping for sleep: Cut a piece of paper tape. Have patient gently close the eye as much as possible. Apply tape horizontally from the mid-cheekbone to just below the eyebrow, ensuring the eyelid is fully closed but without pulling the skin tightly.
Prednisone Administration:• Action: Potent anti-inflammatory and immunosuppressant.• Key Patient Teaching: Take with food to avoid GI upset. Report signs of infection (corticosteroids mask inflammation), black/tarry stools, or significant mood changes. Do not receive live vaccines while on therapy.• NCLEX Alert: Abrupt cessation can cause adrenal insufficiency (weakness, fatigue, hypotension).
A Word from Your Senior Nurse
"Bell's palsy can be frightening for patients—they look in the mirror and see a face that doesn't feel like their own. Our job is twofold: protect their physical health (starting with those vulnerable eyes!) and support their emotional well-being. In clinical practice, I've seen corneal ulcers develop in just a day or two from neglect. Your teaching on eye drops and taping is not just a discharge instruction; it's a critical prevention strategy. On the NCLEX, they love to test your ability to identify the most important problem. With Bell's palsy, never forget: the eye is the prize. Protect it first, and you've done your number one job."